Urban Elderly Population Research Articles

Social and medical risk indicators for 8-year mortality in a Swedish urban elderly population

The aim of this study was to identify and evaluate social and medical risk indicators for mortality in an urban elderly population. Altogether 217 subjects (144 women and 73 men, mean age 78 years, range 69–96 years of age) participated in an examination 1990/91. Eighty-eight persons (55 women and 33 men) had died, and 129 subjects (89 women and 40 men) were alive January 1, 1999. Several risk indicators were found and those with the highest statistical explanatory power to predict mortality were: tremor, inability for heavy housework, a pathological second heart sound, low triceps skinfold, low diastolic blood pressure and decreased appetite. A multivariate model (MVM) utililizing both social and medical risk indicators, and a clinical model (CM) based on the judgement of a registered nurse identified 49 and 34%, respectively, of those who died during the 8-year period ( n=88). A third risk group, the intervention group, comprising individuals selected by either the MVM or CM models, identified 56% of those who died. The latter procedure could be used to define risk groups for mortality in future intervention studies. The combination of social and medical risk indicators in MVM, and a CM might be used in studies with larger sample sizes in order to increase the knowledge in this field.

Epidemiological Study of Susceptibility to Cardiorespiratory Death from Particulate Air Pollution

We conducted a 17 yr time series of mortality in urban elderly populations associated with black smoke (BS) pollution in relation to prior cardiorespiratory emergency hospital admission as a possible index of susceptibility. There were significant associations between BS and all cause mortality in Glasgow and Edinburgh and these were largest following respiratory admissions in those who survived more than 3 yr after their last discharge. These data suggest that emergency hospital admission with respiratory disease may indicate subsequent increasing susceptibility to particulate air pollution.

Relationship between mercury concentration in blood, cognitive performance, and blood pressure, in an elderly urban population.

Concentration of mercury (Hg) in whole blood in an elderly urban population with a mean age of 87 years was studied in relation to cognitive function, arterial blood pressure (arterial BP), age, gender, body mass index (BMI) and smoking habits. This population-based study consisted of 106 subjects both males and females. Clinical assessment of the subjects included medical and social history, physical and neurologic examination and assessment of cognitive functions with Mini-Mental State Examination (MMSE). Information on use of all potentially antihypertensive drugs was collected. Whole blood from 106 subjects were collected and analysed for mercury by Cold Vapour Atomic Absorption Spectrometry (Milton Ray ASS-CV) with Seronorm Trace Element as matrix matched quality control. Males and females did not differ in blood-mercury (B-Hg) concentrations or in any of the other studied variables. B-Hg concentrations did not differ between smokers and non-smokers. Females were treated more often than males with antihypertensive drugs. There was no relation found between B-Hg concentration and cognitive function, arterial BP, age, gender or BMI. In conclusion, no relations were found between B-Hg concentrations and the studied variables.

EPIDEMIOLOGIChESKIE KhARAKTERISTIKI PERELOMOV DISTAL'NOGO OTDELA PREDPLECh'Ya V STARShIKh VOZRASTNYKh GRUPPAKh ZhITELEY EKATERINBURGA

Система комплексной поддержки и сопровождения научного журнала Elpub позволяет запустить двуязычный сайт журнала со встроенной системой электронной редакции в соответствии с лучшими издательскими практиками, а так же предусматривает техническую и методическую поддержку со стороны специалистов НЭИКОН.

Cadmium concentration in blood in an elderly urban population.

Concentration of cadmium in blood in an elderly population with a mean age of 87 years was studied in relation to age, blood pressure, BMI, cognitive function, gender and smoking. This population-based study consisted of 804 subjects both men and women. Clinical examination included medical and social history, physical and neurologic examination, and assessment of cognitive functions with Mini-Mental State Examination (MMSE). Information on prescription and non-prescription drug use was collected. Anti-hypertensive drugs included all medicines potentially used for treating high blood pressure. Blood pressure was measured. Whole blood from 763 subjects was analysed for cadmium by atomic absorption spectrophotometry (GFAAS) with Zeeman background correction and with a graphite furnace using the L'vov platform technique including quality control. Differences in cadmium concentrations were related to non-smokers (3.9 nmol/l), previous smokers (4.4 nmol/l) and current smokers (7.5 nmol/l). There were no relations between cadmium and age, blood pressure or cognitive functions. In conclusion, increased cadmium levels were found in smokers. A possible contribution from previous occupational exposure needs to be further evaluated.

Circumstances of Falls Causing Hip Fractures in the Elderly

A prospective analysis was performed on 832 patients to determine the circumstances surrounding falls leading to hip fracture within a homogeneous, elderly urban population. Special emphasis was placed on the season of year, time of day, location of fall, and other circumstances in which the fracture occurred. All patients were community dwelling, cognitively intact, previously ambulatory elderly who sustained a femoral neck or intertrochanteric fracture. Most fractures occurred at home, particularly in patients who were older, less healthy, and poorer ambulators. More than 75% of fractures resulted from a fall while the patient was standing or walking. Most falls occurred during daylight hours with a peak seen in the afternoon. No seasonal variation in the incidence of hip fractures was observed.

On Scaling Methodology and Environmental Influences in Disability Assessments: The Cumulative Structure of Personal and Instrumental ADL among Older Adults in a Swedish Rural District

The ADL Staircase is a hierarchical instrument for assessment of independence/dependence in personal and instrumental activities of daily living (P-ADL and I-ADL). Its development was based on Katz's ADL-Index, applying the same assessment principles. The cumulativity among the items has previously been confirmed in Swedish urban elderly population samples. The purpose of this study was to test the instrument in a rural setting. Due to local environmental conditions, the authors developed alternative definitions for the “transportation” item. Data collected using 133 respondents suggested a different cumulative order among the I-ADL items from that identified in urban samples, and significant gender differences were found. The scale's cumulativity was analysed in-depth, and it revealed different results depending on which scaling analyses were used. Environmental factors highlighted the methodological difficulties inherent in I-ADL assessments, and the results revealed a higher prevalence of disability compared to previous gerontological studies. In clinical practice, awareness of the consequences of I-ADL assessments' limited generalizability between settings is strongly recommended. The study also has theoretical implications for further understanding of the complexity of disablement.

Subjective quality of sleep and use of hypnotics in an elderly urban population.

To investigate the characteristics and subjective quality of sleep, the use of hypnotics and their correlates in an urban elderly population, a structured interview was administered to a stratified random sample of 600 elderly subjects in five age groups. Interrupted sleep and napping were common; nonetheless, 88% of the subjects considered their sleep at least satisfactory. According to specific criteria, 17% were good, 72% moderate and 11% poor sleepers. Habitual insomnia was reported by 12% of the subjects. Quality of sleep did not differ between age groups or genders. Hypnotics were habitually used by 8% of the men and 25% of the women. Consumption increased with age in both sexes, and 77% of the hypnotics were benzodiazepines. In multivariate regression analyses, insomnia and habitual use of hypnotics were associated with poor health, but only the latter with age and gender. As a conclusion, most of the subjects considered their sleep satisfactory, and aging itself did not seem to have an effect on the quality of sleep. The use of hypnotics was common, more prevalent in women and increased with age. Aging and poor health were independently associated with the use of hypnotics, but not with poor quality of sleep or insomnia.

Predictors of dental use for low-income, urban elderly persons upon removal of financial barriers.

This study examines a low-income, urban elderly population of dental and medical, nondental users. A total of 1,378 medical, nondental users and 2,086 dental users were identified using longitudinal claims data (1983-1992) from a Medicare-waiver program that reimbursed for health care services at cost. Dental users were more likely to be from a younger age cohort (born after 1910, p = .0001) and were more likely to be black (63.3% vs 35.7%, P = .0001) than medical, nondental users. Medical, nondental users had more medical visits (p = .0001), higher medical and pharmacy charges (p = .0001), and more prescriptions (p = .0001) than did the dental users. These findings indicate that among this population of urban elderly, dental users were more likely to be black and have lower medical utilization than nondental users.

Prevalence of blindness and visual impairment in an elderly urban population.

Accurate data on the prevalence of blindness in urban populations is not readily available. The Australian Longitudinal Study of Ageing is a prospective multidimensional study examining a broad range of age-related health issues, including visual function. A population-based sample of 1466 persons, 70 years of age and over, from the Adelaide metropolitan area underwent visual acuity measurement. Approximately 1% were legally blind by Australian definitions. This percentage is low by world standards, however projections indicate that the absolute number of blind elderly people is rapidly increasing. Data such as this are crucial for the planning of adequate ophthalmic care.

The use and effectiveness of assistive devices in an elderly urban population.

The aim of this study was to examine the type, frequency and usage rate of assistive devices in daily life activities in a community-based population aged 70 and over (N = 170), as well as the particular part of the intervention trial which focused on un-met needs, and the usage rate and effectiveness of assistive devices 6 and 12 months after prescription. Among persons under 80 years of age, 24% were users of assistive devices; in the 80 years or above group, this figure rose to 57%. Hygiene and mobility devices were the most common. The usage rate of assistive devices was 84%. The reasons for disuse were an improved health status, or difficulties in using the device. Sixteen percent of the study population had un-met needs of assistive devices. At follow-up visits, the subjects estimated a high degree of effectiveness when using the devices, particularly in the form of reduced difficulty and increment of safety, and increased capacity and ability in various activities. We conclude that the use of assistive devices increases with age, and that most of the assistive devices are used and are effective. As the need for assistive devices changes over time, follow-ups in the home are necessary. Therefore, to meet the needs of a growing elderly population, information about assistive technology should be supplied to both personnel in health care and in the social service system.

Distribution of home help services in an elderly urban population: data from the Kungsholmen Project

Data from the total urban population 75 years and older in Kungsholmen, Stockholm were used to calculate the distribution of home help services. A structured questionnaire was used to collect information about education, occupation, living conditions, Katz Activities of Daily Living Scale, contact with the family, medical treatment and also questions about help needed and functional ability. Home help was considered to be provided when the subjects reported receiving home help service from the municipality. The number of hours of home help and the services received were registered. The results show that 86% of the elderly population in the Municipality of Kungsholmen live in their own homes, even when they are very old. Twenty‐seven percent of those over 74 years and 33% of those over 80 years received home help services. The people receiving help were mostly women, single living, older and with disability detected by the Katz Activities of Daily Living Scale. The predicting factors of hours of home help are older age, condition of single living, disability detected by the Katz Activities of Daily Living Scale and less years of education. Our results also show that, among those who receive home help service, those with disability in the activities of daily living get more hours of help. However, a considerable group of elderly people are disabled but do not receive any home help. Our data stress the need for more attention by health care planners of domiciliary and intensive care and residential facilities for the high risk population (very old, living alone and with disability).

Health and social status of an elderly urban population in Sri Lanka

Although Sri Lanka has generally a young demographic profile, with decreasing overall mortality and birth rates, its population is aging gradually and will continue to do so in the future. In order to have an idea of the needs of the elderly a survey was conducted in a sample of randomly selected Sinhalese elders living in an urban community. Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) assessments were done. Ten percent of the respondents had at least one ADL impairment. Another ten percent had only IADL impairment. The commonest ADL to be affected were bathing and feeding. Children and the family provide all care for the impaired elderly. The family support system should be encouraged and assisted to prevent the necessity for more formal and expensive institutional care. A large proportion of the elderly were handicapped with defects in vision and hearing and the absence of teeth. Correction of these defects would improve both quality of life of these subjects and reduce their risk of accidents.

Hypertension in the elderly population: Prevalence data from an urban area in Sweden

Data from the total urban elderly population (75 years and older) in Kungsholmen, Stockholm, were used to calculate age- and sex-specific prevalence of hypertension. Blood pressure was measured as part of the examination in the population survey (the Kungsholmen Project). The blood pressure of 1751 elderly people and any antihypertensive treatment were recorded. The prevalence of hypertension was 54 and 59 per 100 population for men and women, respectively. No great variation was observed with age or sex. Isolated systolic hypertension was most frequent with increasing prevalence in advanced ages, while isolated diastolic hypertension and systolic and diastolic hypertension showed a tendency of decreased prevalence with age. In the subjects studied, 18% were being treated for hypertension. Hypertension was detected in 47% of those not undergoing treatment. Among those, 76% had high blood pressure measurements. Our data demonstrate that hypertension is a prevalent disease in the very old, in both sexes, and support the need for hypertension screening programs as well as programs to evaluate the efficacy and benefits of treatment in this age group.

Longitudinal patterns of formal and informal social support in an urban elderly population

Stability and change in the use of formal and informal social support was assessed over a three year period among a representative sample of 1855 elderly urban participants in a longitudinal study of aging and health. Whether people received informal, formal, both types of support or no support was determined in baseline, 12 and 24 month personal interviews. Most respondents retained the same form of support across all three interviews. The extent of stability or change varied according to the form of support reported at baseline. Two-thirds of those with no social support continued without support and 40% of those using both informal and formal support continued to do so at subsequent assessments. The substitution of formal for informal support was infrequent and not statistically significant. Pair wise discriminant function analyses of groups of respondents with the most frequent longitudinal support patterns were performed to identify baseline health and social characteristics associated with stable use, the addition of another form of support or change to nonuse, over time. Changes in the use of support were influenced more by initial levels of health and functional status than by social and economic circumstances. Larger proportions of respondents dropped use of support then added an additional form of support. Respondents using both formal and informal support at baseline died across time in higher proportions than those in other support categories. The extent of stability in support use and nonuse, the character of changes in support use across time and greater attrition among those who were the heaviest users of support, serve to create a relative balance in the use of informal and formal support in this aging cohort, at least over the time frame over which respondents were followed in this study.

Incidence and relative risk of dementia in an urban elderly population: findings of a prospective field study

To ascertain the frequency and distribution of new cases of dementing illness in the elderly population of Mannheim (population 308,000), a survey sample of community residents of > 65 years of age was re-examined after an interval of 7-8 years, and a sample of elderly persons in long-stay care after 5-6 years. The estimated annual incidence rate for all forms of dementia, after correction for ageing of the samples, was 15.4 per 1000 persons aged > 65, made up of dementia of Alzheimer type (8.9 per 1000), vascular dementia (4.4 per 1000) and other forms (2.1 per 1000). Apart from the expected association with age > 65 years, the most powerful predictors of onset of a dementing illness were residence in long-stay care and the presence of minor cognitive deficits at the initial examination, each of which was associated with a highly significant increase in risk. In addition, a number of socio-demographic characteristics (marital status, occupational history and quality of present living accommodation) was found to be predictive, though analysis of larger samples or pooled research data would be necessary to establish their importance in this respect. The findings suggest that identification of mild cognitive impairment on screening could prove helpful in assessing risk for dementia from two to three years before the condition becomes clinically apparent.

Subjective Memory Complaints and Personality Traits in Normal Elderly Subjects

To evaluate the relationship between objectively measured memory functions and subjective complaints of memory disturbance and whether subjective complaints are affected by some personality traits or affective states. Cross-sectional two-group comparison. The city of Kuopio in Eastern Finland, considered representative of the urban elderly population of Finland. Originally 403 subjects aged 67-78 years from the random sample and then two matched study groups initially including eighteen subjects but only ten in the final analysis. Screening and follow-up examinations of subjects with and without subjective memory complaints: (1) Memory functions: Benton's visual retention test and the paired-associated learning subtest of Wechsler Memory Scale. (2) Memory complaints: Memory Complaint Questionnaire. (3) Personality traits and affective state: Two subscales from Minnesota Multiphasic Personality Inventory and Geriatric Depression Scale. Complaints of memory loss did not correlate with the actual memory performance in the tests. However, those subjects who most emphatically complained of memory disturbance had greater tendencies toward somatic complaining, higher feelings of anxiety about their physical health, and more negative feelings of their own competence and capabilities than those who did not complain of memory deterioration associated with aging. The study suggests that subjective feelings of memory impairment are more closely associated with personality traits than with actual memory performance in normal elderly people.

Medication Use Patterns Among a Noninstitutionalized Urban Elderly Population

Medication Use Patterns Among a Noninstitutionalized Urban Elderly Population

Intake of energy, nutrients and food items in an urban elderly population.

This study is part of a transcultural investigation under the auspices of the International Union of Nutritional Sciences, where dietary habits are studied with similar methodology in different populations throughout the world. The present paper describes and evaluates the intake of energy and nutrients, and food habits in an urban elderly population in Sweden, in relation to existing standards. The study population comprised 66 males and 122 females, aged 70 years and over (average 78 years) living in the city of Gothenburg. Energy intake was on average 11.5 MJ in males and 9.9 MJ in females. Nutrient intakes were on average above recommendations, and neither intake nor food choice seemed to change much with increasing age. A validation by a 4-day record and 24-hour urinary nitrogen determination was performed in a subsample, and indicated a probable systematic overestimation of at least 10% for protein consumed. The data from this study support the view that people 70 years of age and older in Sweden are generally healthy, active and have good food habits. This population, however, was not a representative sample. They were all living in a well defined area, with a stable social situation, and belonged generally to middle class. With this background the nutrient data seem reasonable. As long as elderly people stay healthy and do not have other serious risk factors, they seem to keep good food habits and nutritional status up into their eighties and nineties.

Medication Use Patterns Among a Noninstitutionalized Urban Elderly Population

No abstract available for this article.